中重型颅脑损伤置管病人分段梯度随访模式的实践研究

Practical research on segmented gradient follow-up model of catheterization patients with moderate and severe traumatic brain injury

[目的]对中重型颅脑损伤置管病人实施分段梯度随访,观察其对颅脑损伤病人生活质量的影响。[方法]选择神经外科病房64例符合条件的颅脑损伤置管病人,随机分为试验组(34例)和对照组(30例),试验组采用分段梯度随访模式,即将中重型颅脑损伤置管病人的随访过程分为3部分(在院期、随访早期、随访后期),以团队协作的随访方式基于小组形式按康复阶段管道的不同需求,全程贯穿评估—实施—评价,自制管道跟踪卡并结合3人成组互推模式对病人进行跟踪随访。对照组进行康复护理指导、常规出院宣教和一般家庭随访结合门诊复查。两组病人于出院后3个月、6个月、12个月时进行Karnofsky预后评定表、日常生活能力(ADL)和生活满意度评定,并观察并发症和置管意外的发生情况,[结果]出院后1年两组并发症发生率和意外情况发生率差异有统计学意义(P<0.05),6个月时两组生活满意度差异有统计学意义(P<0.05);6个月、12个月时Karnofsky预后和ADL评分比较差异均有统计学意义(P<0.05)。[结论]实施分段梯度随访对改善中重型颅脑损伤置管病人的机能状态及日常生活能力、降低病人并发症和意外情况的发生率等方面有积极促进作用。

Objective：To carry out segmented gradient follow-up for cath- eterization patients with moderate and severe traumatic brain injury, and observe the influence on quality of life of patients with severe craniocere- bral injury. Methods. A total of 64 cases of eligible craniocerebral injury pa- tients receiving catheterization in neurosurgery ward were randomly divid- ed into two groups, the treatment group （34 cases） and the control group （30 cases）. The treatment group patients used segmented gradient follow- up models, that was to divide follow - up process into 3 parts （hospital stay, early follow - up,later follow - up）, the teamwork follow - up collab- oration based on small groups was used, according to different pipes re- quirements in rehabilitation stages, the full process ran through assess- ment- implementation- evaluation and homemade pipeline tracing cards were used,and combined with 3 persons pushed each other in groups model for follow- up of patients. The control group patients received rehabilita- tion nursing guildance, conventional discharge missionary and general fam- ily follow - up and outpatient review. The two groups of patients were eval- uated on Karnofsky prognostic form, activity of daily living and life satis- faction, and to observe incidence of complications and catheter accidentally in 3rd month, 6th month, 12th month after discharging. Results ： There was statistically significant difference in incidences of complications and acci- dents between both groups in first year after discharging（P^0.05）, life satisfaction was statistically different in 6th month after discharging be- tween both groups （P^0.05）,there was statistically significant difference in Karnofsky prognosis and ADL score in 6th month and 12th month after discharging （P^0.05）. Conclusion ： Implementation of the segmented gra- dients follow - up had a positive role in improving the functional status and daily living skills of the catheterization patients with moderate and severe traumatic brain injury, reducing the incidence of complications and acci- dents in patients.